Anxiety and depression in young physicians: Prevalence and associated factors. The MESSIAEN national study.

BACKGROUND: Physicians are at risk of anxiety and depression. OBJECTIVES: To determine the prevalence of anxiety and depression in a national sample of young physicians and their associated factors. METHODS: The study is a cross-sectional observational epidemiological national study. An online anonymous questionnaire was administered to the young physicians of all French medical faculties. Anxiety and depression were assessed with the Hamilton Anxiety & Depression scale subscores for anxiety and depression. Psychotropic drug consumption, psychotherapy follow-up and other variables were self-declared. RESULTS: Of the 2003 study participants, 32.3% reported a current anxiety disorder and 8.7% a current major depressive disorder according to their HAD scores and less than one on five of them was followed-up in psychotherapy or treated by antidepressant. Moral harassment, a bad quality of initial formation regarding dealing with disease and alcohol consumption were all associated with respectively anxiety disorder and major depression in multivariate analyses. Medical vocation was specifically associated with decreased major depression while being woman and increased coffee consumption were specifically associated with increased anxiety disorders. CONCLUSION: Almost one third of medical students reported anxiety disorder or major depression and less than one on five received the recommended treatment (psychotherapy or antidepressant). The prevention and treatment of psychiatric disorders should be improved in this population. Moral harassment exposure, alcohol and coffee consumptions, bad quality of initial formation regarding dealing with disease have been identified as modifiable factors associated with poor mental health. Despite the absence of causal associations, these results yield some clues to guide future mental health prevention strategies in this population.

Prevalence and associated factors of cannabis consumption in medical students: the BOURBON nationwide study.

France has been identified with one of the highest rates of cannabis consumption of Western European countries. Yet we lack data in medical students who are at risk of addictive behavior. The objective of the study is to determine the prevalence of cannabis consumption and cannabis use disorder (CUD) among French medical students and their association with psychotropic drug consumption and psychosocial factors. Medical students were recruited from 35 French universities of medicine through administration mailing lists and social networks, between December 2016 and May 2017. Cannabis consumption was self-declared by anonymous questionnaire and CUD was defined by a Cannabis Abuse Screening Test (CAST) score ≥ 3. 10,985 medical students with a mean age of 21.8 years (± 3.3) were included, 32% of which were men. Overall, 1642 [14.9 (14.3; 15.6)%] reported cannabis consumption and 622 [5.7 (5.2; 6.1)%] students were identified with CUD at screening. Men were at two-time higher risk of cannabis consumption and three-time higher risk of CUD (22.4% and 10.6% for men vs. 11.5% and 3.4%, respectively, for women). In multivariate analyses, men sex, alcohol use disorder, tobacco smoking, parents' divorce, and history of physical assault and lower rates of lower rates of ≥ 40 weekly worked hours were identified as common associated factors for cannabis consumption and CUD. Hypnotic consumption, psychiatric follow-up, and history of sexual assault were identified as factors associated specifically with CUD, suggesting that these factors were associated with more severe cannabis consumption. Only 17% of students identified with CUD reported a psychiatric follow-up. Altogether, these results suggest that health policies should target cannabis consumption in medical students that is frequent, especially in men, with low rates of psychiatric follow-up. We have identified psychological factors and increased hypnotic drug consumption in CUD participants suggesting that psychiatric follow-up should be systematically proposed to this group.

Hazardous drinking is associated with hypnotic consumption in medical students in the BOURBON nationwide study: psychological factors explored.

France has been identified with one of the highest rates of hazardous drinking and hypnotic consumption in Western countries. Medical students have been identified at risk for hazardous drinking yet we lacked of national data on their hypnotic consumption and associated factors to guide public health policies. To determine the prevalence of hazardous drinking and dependence among French medical students and their association with psychotropic drug consumption and psychosocial factors. Medical students were recruited from 35 French universities of medicine through administration mailing lists and social networks, between December 13, 2016 and May 15, 2017. Hazardous drinking was defined by an Alcohol Use Disorder Identification Test (AUDIT) score ≥ 7 for men and ≥ 6 for women. 10,985 medical students with a mean aged of 21.8 years (± 3.3) were included, 32% of which were male. Overall, 3713 (34%) students reported hazardous drinking (41% for men vs. 31% for women) and 820 participants (8%) reported alcohol dependence (12% for men vs. 6% for women). In multivariate analyses, hazardous drinking was independently associated with age, male gender, hypnotic consumption, psychiatric follow-up, mourning, parents divorce, exposure to sexual and physical assault. Alcohol dependence was associated with male gender, tobacco and cannabis consumption, and sexual and physical assault. Second year was reported as the year at higher risk for increased alcohol consumption vs. decreased risk in first and fourth year. Hazardous drinking identified in one third of medical students is associated with hypnotic consumption and some psychological factors suggesting self-medication behavior that could be targeted by psychological interventions.

Repeated bullying at the workplace in medical students and young doctors: the MESSIAEN national study.

Despite clues indicating high Bullying at the Work Place (BWP) rates in French hospitals, there has been no quantitative study so far. To determine the prevalence of repeated BWP in a national sample of French young physicians; its risk factors, and the mental health consequences of BWP. The study is a cross-sectional observational epidemiological national study addressed to young physicians. The online internet anonymous questionnaire was elaborated according to previous studies exploring BWP. In addition, we explored the quality of initial training. BWP was defined according to the French legal definition. Mental health was assessed by Hamilton Anxiety and Depression scale, psychotropic drug consumption and psychotherapy follow-up. A Structured Equation Modeling (SEM) was carried out to confirm our theoretical model. 2003 participants of the 37 French medical faculties were included. At least one history of BWP was identified in 41.7% of the participants. The SEM model showed good fit (RMSEA = 0.025, CFI = 0.93, TLI = 0.92, WRMR = 1.285). In the SEM model, BWP was associated with age and number of monthly night shifts and weekly worked hours. Obstetric gynecology, psychiatry, surgery, and medical specialties and low-quality initial training were associated with higher risk of BWP. BWP was associated with increased anxiety and depressive symptoms, daily antidepressant and anxiolytic consumption, and psychotherapy follow-up. Decreasing worked hours and night shifts and improving the quality of the initial training may help preventing BWP among medical students and young physicians. Obstetric gynecology, surgical and medical specialties, and psychiatry should be targeted with a focus on developing prevention programs.

Cross-Cultural Adaptation and Validation of the Quality of Life Questionnaire for Caregivers of Patients with Schizophrenia (S-CGQoL) in Latin America.

OBJECTIVES: The aim of this study was to adapt and validate the Schizophrenia Caregiver's Quality of Life Questionnaire (S-CGQoL) for use in the Hispanic-American population from the caregiver's perspective. METHODS: A cross-sectional instrumental model was used, with a sample of 253 caregivers of patients suffering of Schizophrenia in Bolivia, Peru and Chile. The psychometric properties of the S-CGQoL were tested through construct validity, reliability and some aspects of external validity. In addition, in order to assess the nature of the different items across the three countries, a Differential Performance Analysis (DPA) was conducted. RESULTS: A confirmatory factor analysis showed that the scale structure was well correlated to the initial structure of the QoL-MDS. The results confirmed the existence of adequate reliability indicators (α>.70 and ω>.80) and the absence of FIDs supporting the invariance of item calibrations among the three Latin American countries. CONCLUSIONS: The adaptation and validation of the S-CGQoL questionnaire demonstrate adequate psychometric properties to assess the quality of life of caregivers in samples of middle-income countries in Latin America.

[Exposure to professional violence by young physicians in the hospital: MESSIAEN national study]. / Exposition aux violences professionnelles à l'hôpital chez les jeunes médecins : l'étude nationale MESSIAEN.

BACKGROUND: Hospital professional violence is defined as hostile and aggressive behavior exerted by health professionals on other health professionals. No quantitative study has been carried out to date on French hospital professional violence among young physicians, while recent qualitative studies have suggested a potential high frequency. The main objective was to determine the prevalence of exposure of young doctors to hospital violence. The secondary objective was to determine their characteristics and consequences as well as to determine if students and young physicians (resident and young MD) differed. METHODS: The study was a national cross-sectional observational epidemiological study that included 4th-year medical students and young physicians (MD for less than 2 years). Thirty-seven French faculties of medicine were contacted for email recruitment of participants. Social networks were used to increase the visibility of the study. The questionnaire was developed after exhaustive review of the international literature dealing with professional violence in hospitals, its characteristics and its consequences in terms of mental health, addiction, personal and professional life. The report of these events was also explored. RESULTS: In total, 2003 participants have been included. More than nine out of ten participants were exposed to hospital violence at least once and nearly 42% to moral harassment as defined by the French law. This violence does not differ between the students and the residents/young MDs, suggesting that working time in the hospital does not seem to affect this risk. Nearly 80 % of interns and young MDs reported working more than the legal time. The perpetrators of violence include in almost all cases at least one man, often a senior doctor, but students reported the presence of at least one woman among the perpetrators in ¾ of cases. The victims are as often men as women. Compared to the undergraduate medical students, residents and young MDs more frequently reported poor outcomes on their mental health, addictive behavior, personal and professional lives. The majority of victims reported the event to a peer but fewer than 10% to the head of the department, a professor or an instance that could have acted. In almost all cases, participants reported the continuation of abusive behavior after the event. In total, 42% of students think that this is simple part of medical studies that they must endure. CONCLUSION: These results suggest the need to develop specific information and prevention programs for professional hospital violence in France.

[Secondary surgery of breast reconstructions by breast implant. Assessment of patient satisfaction based on surgical technique implant conservation vs. autologous conversion]. / Chirurgie secondaire des reconstructions mammaires par prothèses. Évaluation de la satisfaction des patientes selon la technique chirurgicale : conservation d'implant vs conversion autologue.

INTRODUCTION: Breast reconstruction with implants has long-term disadvantages and is leading an increasing number of patients to request secondary corrective surgery. Two surgical strategies are possible: implant replacement (associated with capsulectomy/capsulotomy and/or lipofilling procedures) and implant removal associated with the provision of autologous tissue (flap and/or lipofilling). METHOD: Between 2010 and 2018, 54 patients underwent secondary surgery for correction of a first implant breast reconstruction. The reasons for dissatisfaction with the initial reconstruction, the procedures performed, and postoperative complications were analysed. Patient well-being and satisfaction were evaluated using the BREAST-Q questionnaire. RESULTS: Thirty-four patients benefited from a prosthesis change and 20 patients benefited from a permanent removal of their prosthesis combined with the addition of autologous tissue. The presence of a periprosthetic shell, pain, fixed appearance of the breast and breast asymmetry were the most frequent reasons for dissatisfaction. With a mean follow-up of 2.6 years, autologous conversion patients were generally more satisfied with the appearance of their breasts than patients who retained a breast implant (P<0.0001). CONCLUSION: In cases of poor esthetic or functional outcomes of implant-based breast reconstruction, removal of the prosthesis in combination with autologous reconstruction provides better results in terms of well-being and satisfaction than implant replacement.

Homeless women with schizophrenia reported lower adherence to their medication than men: results from the French Housing First experience.

OBJECTIVE: The aim of this study was to investigate the factors associated with non-adherence to medication in a large multi-center sample of homeless schizophrenia (HSZ) patients. METHODS: This multi-center study was conducted in four French cities: Lille, Marseille, Paris, and Toulouse. In addition to the Medication Adherence Rating Scale (MARS), sociodemographic information, history of homelessness, illness severity using the Modified Colorado Symptom Index (MCSI) and the Multnomah Community Integration Scale (MCAS), and drug information were collected. RESULTS: In total, 218 HSZ patients (16.1% women, mean age 36.8 ± 9.3 years) were included in this study. In the multivariate analysis, being a woman and having higher illness severity (MCSI score) and lower "acceptance of illness" (MCAS score) were significantly associated with lower MARS index scores. Compared to men, women had lower MARS dimension 1 ('medication adherence behavior') and dimension 3 ('negative side effects and attitudes toward psychotropic medication') scores. First-generation antipsychotic use was also associated with lower MARS dimension 3 scores. CONCLUSION: HSZ women reported lower adherence than men, mainly due to having more subjective negative side effects and worse attitudes toward psychotropic medication. Future longitudinal studies should confirm these findings and explore the applicability of specific pharmacological and non-pharmacological treatment strategies for HSZ women, including treatment dose adaptation and psychoeducation. Clinical trial number NCT01570712.

Predictors of quality of life in patients with relapsing-remitting multiple sclerosis: a 2-year longitudinal study.

INTRODUCTION: Knowledge of which factors are determinant of quality of life (QoL) in patients with multiple scleroris (MS) would assist clinicians in choosing the most appropriate interventions. The aim of this study was to determine the contribution of sociodemographic and clinical factors in the predicting QoL in a 2-year cohort of patients with relapsing-remitting MS (RR-MS). METHODS: The study had a multi-center, multi-regional, and longitudinal design. Main inclusion criteria were: patient with a RR-MS subtype (McDonald criteria) and an Expanded Disability Status Scale (EDSS) score lower than 7.0. Sociodemographic (age, gender, education level, marital and employment status) and clinical (disability, disease duration, relapse) data were recorded. The QoL was assessed using the MusiQoL (disease-specific) and SF-36 (generic) questionnaires. Each patient was investigated at baseline and 24 months post-inclusion (ClinicalTrials.gov identifier: NCT00702065). RESULTS: Five hundred and twenty-six patients were enrolled in the present study. The 24-month MusiQoL index score was significantly inversely correlated with the disease duration. Baseline EDSS score impacted in both 'physical-like' and 'psychological-like' dimensions. At least one relapse during the follow-up period was associated with lower physical scores. Occupational status and marital status were associated with 24-month scores of MusiQoL and SF-36. CONCLUSION: After adjusting for disability and relapse occurrence, sociodemographics (age, marital status, and occupational status) and baseline QoL scores were also independent QoL predictors in MS patients. Special attention should be given to subgroups to ensure optimal management.

Health-related quality of life as an independent predictor of long-term disability for patients with relapsing-remitting multiple sclerosis.

BACKGROUND AND PURPOSE: Predictive factors of long-term disability in patients with relapsing-remitting multiple sclerosis (RR-MS) are well known, but the weight of these factors does not explain the entire change of disability. Few studies have examined the predictive value of quality of life (QoL). OBJECTIVES: To determine the value of the initial level of QoL to predict changes in the disability status of patients with MS and to determine if specific-MS questionnaires predict more accuracy in these changes than generic questionnaires. DESIGN: multicenter, multi-regional, and longitudinal study. Main inclusion criteria: patients with RR-MS subtype and an Expanded Disability Status Scale (EDSS) score lower than 7.0. Sociodemographic and clinical data were recorded at baseline. Every 6 months up to month 24, QoL (MusiQoL and SF-36) was recorded. At 24 months, individuals were defined into two 'disability change' groups: the worsened and not worsened patients. RESULTS: Five-hundred and twenty-six patients were enrolled: 386 (83.7%) not worsened and 75 (16.3%) worsened patients at 24 months. The activity of daily living and the relationship with healthcare workers dimensions of MusiQoL questionnaire were independent predictors of change in the EDSS score after 24 months. The physical-functioning dimension of the SF-36 questionnaire predicted independently disability change after 24 months. CONCLUSIONS: Patient-reported baseline QoL levels provide additional prognostic information on MS disability beyond traditional clinical or sociodemographic factors. These findings reinforce the importance of incorporating a patient's evaluation of their own QoL level during patient monitoring and the assessment of treatment effects.

Gestational Age, Socioeconomic Context and Infection-Related Hospital Admissions of Infants Born With Gestational Age Less Than 33 Weeks.

Using data from a regional medical follow-up network database of preterm infants born with gestational age (GA) <33 weeks, we found that low GA and deprived socioeconomic neighborhoods increased incidence of infection-related hospitalization during the first year of life. Respiratory tract infections rates were higher in extremely preterm infants.

Housing First for homeless people with severe mental illness: extended 4-year follow-up and analysis of recovery and housing stability from the randomized Un Chez Soi d'Abord trial.

AIMS: Housing First (HF), a recovery-oriented approach, was proven effective in stabilising housing situations of homeless individuals with severe mental disorders, yet had limited effectiveness on recovery outcomes on a short-term basis compared to standard treatment. The objective was to assess the effects of the HF model among homeless people with high support needs for mental and physical health services on recovery, housing stability, quality of life, health care use, mental symptoms and addiction issues on 4 years of data from the Un Chez Soi d'Abord trial. METHODS: A multicentre randomised controlled trial was conducted from August 2011 to April 2018 with intent-to-treat analysis in four French cities: Lille, Marseille, Paris and Toulouse. Participants were homeless or precariously-housed patients with a DSM-IV-TR diagnosis of bipolar disorder or schizophrenia. Two groups were compared: the HF group (n = 353) had immediate access to independent housing and support from the assertive community treatment team; the Treatment-As-Usual (TAU) group (n = 350) had access to existing support and services. Main outcomes were personal recovery (Recovery Assessment Scale (RAS) scale), housing stability, quality of life (S-QoL), global physical and mental status (Medical Outcomes Study 36-item Short Form Health Survey (SF-36)), inpatient days, mental symptoms (Modified Colorado Symptom Index (MCSI)) and addictions (Mini International Neuropsychiatric Interview (MINI) and Alcohol Use Disorders Identification Test (AUDIT)). Mixed models using longitudinal and cluster designs were performed and adjusted to first age on the street, gender and mental disorder diagnosis. Models were tested for time × group and site × time interactions. RESULTS: The 703 participants [123 (18%) female] had a mean age of 39 years (95% CI 38.0-39.5 years). Both groups improved RAS index from baseline to 48 months, with no statistically significant changes found between the HF and TAU groups over time. HF patients exhibited better autonomy (adjusted ß = 2.6, 95% CI 1.2-4.1) and sentimental life (2.3, 95% CI 0.5-4.1), higher housing stability (28.6, 95% CI 25.1-32.1), lower inpatient days (-3.14, 95% CI -5.2 to -1.1) and improved SF-36 mental composite score (-0.8, 95% CI -1.6 to -0.1) over the 4-year follow-up. HF participants experienced higher alcohol consumption between baseline and 48 months. No significant differences were observed for self-reported mental symptoms or substance dependence. CONCLUSION: Data at 4 years were consistent with 2-year follow-up data: similar improvement in personal recovery outcomes but higher housing stability, autonomy and lower use of hospital services in the HF group compared to the TAU group, with the exception of an ongoing alcohol issue. These sustained benefits support HF as a valuable intervention for the homeless patients with severe mental illness. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01570712.

Meningiomas in patients with long-term exposition to progestins: Characteristics and outcome.

OBJECTIVE: The aim of this study was to describe progestin-associated meningiomas' characteristics, outcome and management. MATERIAL AND METHODS: We included 53 patients operated on and/or followed in the department for meningioma with progestin intake longer than one year and with recent drug discontinuation. RESULTS: Cyproterone acetate (CPA), nomegestrol acetate (NomA), and chlormadinone acetate (ChlA) were involved in most cases. Mean duration of progestin drugs intake was 17.5 years. Tumors were multiple in 66% of cases and were located in the anterior and the medial skull base in 71% of cases. Transitional subtype represented 16/25 tumors; 19 meningiomas were WHO grade I and 6 were grade II. The rate of transitional subtype and skull base location was significantly higher compared to matched operated meningioma general population. No difference was observed given WHO classification. But Ki67 proliferation index tends to be lower and 5/6 of the WHO grade II meningiomas were classified as WHO grade II because of brain invasion. Strong progesterone receptors expression was observed in most cases. After progestin discontinuation, a spontaneous visual recovery was observed in 6/10 patients. Under CPA (n=24) and ChlA/NomA (n=11), tumor volume decreased in 71% and 18% of patients, was stabilized in 25% and 64% of patients, and increased in 4% and 18% of patients, respectively. Volume outcome was related to meningioma location. CONCLUSIONS: Outcome at progestins discontinuation is favorable but different comparing CPA versus ChlA-NomA and comparing tumor location. Long-term follow-up is required. In most cases, simple observation is recommended and surgery should be avoided.

No specific adverse pregnancy outcome in singleton pregnancies after assisted reproductive technology (ART) for unexplained infertility.

OBJECTIVE: To evaluate the obstetrical outcome of pregnancies obtained after assisted reproductive technology (ART).in women with unexplained infertility. MATERIALS AND METHODS: We conducted a retrospective observational case - control cohort study between January 2011 and May 2017. All pregnancies obtained after ART (Intra uterine insemination, In Vitro Fertilization, Intra Cytoplasmic Sperm Injection) were included. The ART pregnancy outcome of women with unexplained infertility was compared to ART pregnancies obtained in a context of male infertility. Cases were matched to controls (1:2) for age, Body Mass Index (BMI), and smoking status. RESULTS: After exclusion of twins, we studied 67 singleton pregnancies in the case group, matched with 129 singleton pregnancies in the control group. The first-trimester complications (miscarriage before 12 weeks gestation (WG), ectopic pregnancy) were similar in the two groups. Concerning the 2nd and the 3rd trimester, the incidence of gestational diabetes mellitus, pre-eclampsia, placenta previa, preterm labor was comparable between the two groups. In singletons, we found a non-significant increase of post-partum hemorrhage (OR=5.5, IC 0.5-50, p=0.13) and small for gestational age new-borns (OR=3.45, IC 0.65-18.1, p=0.14) in women with unexplained infertility. CONCLUSION: More adverse obstetrical outcome are commonly reported after ART, even in singleton pregnancies. Little is known for explaining it and to distingue the own contributions of ART techniques and of the infertility etiology. In our study, we didn't observe a significant negative impact of a history of unexplained infertility on pregnancy. However, further large studies are needed to evaluate more accurately the possible liabilities of the infertility etiology on obstetrical and perinatal outcome.

Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial.

AIMS: Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. METHODS: We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. RESULTS: Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). CONCLUSION: An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.

Improving the treatment and remission of major depression in homeless people with severe mental illness: The multicentric French Housing First (FHF) program.

AIMS: The objectives of the present study were to determine the rates and associated factors of (i) MDD, (ii) antidepressant prescription and (iii) MDD non-remission in homeless subjects with bipolar disorder (BD) or schizophrenia (SZ). METHODS: This multicenter study was conducted in 4 French cities. MDD was defined with the section L of the MINI. Unremitted MDD was defined by current antidepressant treatment and current MDD. RESULTS: 700 subjects, mean aged 38 years and 82.5% men were included: 55.4% were diagnosed with MDD but only 10.4% were administered antidepressants. Violent victimization in the past 6 months, alcohol use disorder and current substance abuse disorder were associated with increased rates of MDD. 71.2% antidepressant-treated subjects were unremitted. BD diagnosis and substance abuse disorder were found to be associated with increased risk of unremitted MDD. BD-MDD patients were found to be twice more frequently administered antidepressants than SZ-MDD ones, however the non-remission rates were higher in BD subjects compared to SZ. No antidepressant class and no specific antipsychotic or mood stabilizer has been associated with higher or lower rates of remitted MDD. CONCLUSION: MDD seems to be highly prevalent, underdiagnosed and undertreated in BD and SZ homeless subjects. Beyond antidepressants, add-on strategies including complementary agents, lithium, lamotrigine/carbamazepine or anti-inflammatory drugs and the specific care of alcohol and substance use disorders may be recommended to improve the prognosis of this specific population in addition to other interventions including housing and resocialization. Violent victimization is also frequent and should be specifically prevented in this vulnerable population.

First-year French medical students consume antidepressants and anxiolytics while second-years consume non-medical drugs.

BACKGROUND: First year exams are a major source of stress amongst first-year medical students. OBJECTIVE: To explore antidepressant and anxiolytic consumption and addictive behavior of medical students before and after exams. METHODS: Medical students of the 35 French medical schools were recruited through mailing lists and social networks between December 2016 and May 2017 and completed online Internet anonymized questionnaires. RESULTS: Overall, 4345 medical students were included (3051 first year vs. 1294 second year). In multivariate analyses, compared to those in the first year of medicine, second year students were found to have lower anxiolytic (adjusted odd ratio (aOR)=0.56, p = 0.01) and antidepressant consumption (aOR=0.21, p<0.0001) but higher psychiatric follow-up (aOR=1.95, p<0.0001) after adjustment for age, gender and relationship status. Whilst second year students reported slightly higher quality of life (especially for mental health), they also reported more daily tobacco smoking (aOR=1.78, p<0.0001), more cannabis use disorders (aOR=2.37, p<0.0001), hazardous drinking (aOR=3.61, p<0.0001), and alcohol dependence (aOR=3.66, p<0.0001). Second year medical students reported fewer difficulties relating to studying in comparison to first year students (aOR=0.60, p<0.0001) yet they reported a higher rate of recreational drugs use with a variety of reasons including self-treatment of anxiety; disinhibition and to copy their peers (all p<0.05). LIMITS: These results should be confirmed by longitudinal studies. CONCLUSION: First year medical students who are faced with challenges relating to studying consume more antidepressants and anxiolytics, whilst second year students have a higher consumption of recreational drugs for a range of reasons. This suggests that the first two years at medical school are an important contributor to adverse mental health and therefore present a window of opportunity for preventative intervention.

Sexual harassment exposure and impaired mental health in medical students. The MESSIAEN national study.

BACKGROUND: A previous national study has suggested that around 20% of French working women reported sexual harassment (SH) at work but we lack of data in medical students of French hospitals to guide prevention programs. OBJECTIVES: To determine SH prevalence in a national sample of French medical students and to validate a theoretical model explaining SH causes and its impact of mental health. METHODS: The study is a cross-sectional observational epidemiological national study. SH was defined according to the French legal definition. We further explored other discriminations and their potential association with impaired mental health in medical students. Mental health was assessed by Hamilton Anxiety & Depression scale, psychotropic drug consumption and psychotherapy follow-up. A Structured Equation Modeling was carried out to confirm our theoretical model. RESULTS: 2003 participants were recruited. SH was reported by 15.7% of the participants (19.8% of women and 5.2% of men). The SEM model showed good fit (RMSEA=0.024, CFI=0.90, TLI=0.87, WRMR=1.165). SH was associated with risk factors such as feminine gender and surgical and anesthesiology specialties. SH was also associated with exposure to discriminations based on the specialty choice and sexual orientation. SH was associated with impaired mental health. CONCLUSION: French medical student women reported similar rates of SH than other working women, suggesting that SH prevention programs are needed in French hospitals. Surgery and anesthesiology should be targeted in priority. The prevention programs should also target other discriminations and should be evaluated in terms of potential mental health improvement.

The need to improve detection and treatment of physical pain of homeless people with schizophrenia and bipolar disorders. Results from the French Housing First Study.

OBJECTIVE: The aim of this study was to investigate the prevalence and associated factors of physical pain in a large multicenter sample of Homeless Schizophrenia and Bipolar (HSB) patients. METHODS: This multicenter study was conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. Pain was measured by EQ5D-3 L questionnaire with no specified period or location. In addition, sociodemographic information, duration of homelessness, illness severity using the Modified Colorado Symptom Index (MCSI) and drug information were collected. RESULTS: Overall, 655 HSB patients, mean age 38.8 years and 82.6% men were included, 448 (68.9%) were diagnosed with schizophrenia and 202 (31.1%) with bipolar disorder. More than half patients (N = 337, 51.5%) reported moderate to extreme physical pain while only 2.7% were administered analgesic drugs. In the multivariate analysis, self-reported moderate to extreme physical pain was associated with antidepressant consumption (adjusted odd ratio aOR = 2.56[1.25;5.26], p = .01), female gender (aOR = 1.72[1.03;2.86], p = .04), bipolar disorders (vs. schizophrenia) (aOR = 1.81[1.19;2.77], p = .006), older age (aOR = 1.03 [1.01;1.05], p = .01), with higher MCSI psychotic score (a0R = 1.04[1.01;1.06],p = .002), independently of the number of days in the street during the last 180 days, MCSI depression score, alcohol and substance use disorders, psychotropic drugs and analgesic treatments. No association with education level, antipsychotics, mood stabilizers, anxiolytic, hypnotic or medication adherence was found (all p > .05). CONCLUSION: Physical pain was highly reported in homeless patients with severe mental illness with insufficient care. Physical pain should be systematically explored and treated in this population. Bipolar disorders, antidepressant consumption and female gender may be targeted in priority. Age and psychotic symptomatology were found to influence self-reported pain in a marginal way.

Prescription of potentially inappropriate psychotropic drugs in homeless people with schizophrenia and bipolar disorders. Results from the French Housing First (FHF) program.

BACKGROUND: Guidelines have been edited for the treatment of schizophrenia (SZ) and bipolar disorders (BD). Background regimen is currently recommended for both illnesses (antipsychotic drug for SZ and mood stabilizer for BD). The recommendations are less clear for major depression in these disorders. Long-term anxiolytic and hypnotic prescriptions may have potential side effects and should be withdrawn as soon as possible. OBJECTIVE: The aim of this study was to investigate the prevalence and associated factors of Potentially Inappropriate Psychotropic drugs (PIP) in a large multicenter sample of Homeless Schizophrenia (SZ) and Bipolar Disorder (BD) (HSB) patients. METHODS: This multicenter study was conducted in 4 French cities: Lille, Marseille, Paris and Toulouse. PIP was defined by at least one item among: (i) absence of background regimen (antipsychotic for SZ or mood stabilizer for BD), (ii) absence of antidepressant for major depressive disorder and (iii) daily long-term anxiolytic or (iv) hypnotic prescription. RESULTS: Overall, 703 HSB patients, mean aged 38 years and 82.9% men were included, 487 SZ (69.3%) and 216 BD (30.7%). 619 (88.4%) of the patients reported at least one PIP. 386 (54.9%) patients had an inappropriate background regimen prescription (209(43.4%) of SZ had no antipsychotic prescription and 177(81.9%) of BD no mood stabilizer), 336 (48%) had an inappropriate antidepressant prescription (with no significant difference between SZ and BD), 326 (46.4%) had an inappropriate prescription of anxiolytics and 107 (15.2%) had an inappropriate prescription of hypnotics. 388(55%) of the subjects were diagnosed with major depression but only 52(13%) of them were administered antidepressants. In multivariate analysis, PIP was associated with bipolar disorder diagnosis (aOR = 4.67 [1.84-11.89], p = 0.001), current major depressive disorder (aOR = 27.72 [9.53-80.69], p < 0.0001), lower rate of willingness to ask for help (aOR = 0.98[0.96-0.99], p = 0.001). Potentially inappropriate background regimen prescription was associated with bipolar disorder diagnosis (aOR = 6.35 [3.89-10.36], p < 0.0001), lower willingness to ask for help (aOR = 0.99[0.98-0.99], p = 0.01) and lack of lifetime history of psychiatric care (aOR = 0.30[0.12-0.78], p = 0.01). Inappropriate antidepressant prescription was associated with antisocial personality disorder (aOR = 1.58 [1.01-2.48], p = 0.04) and current substance use disorder (aOR = 2.18[1.48-3.20], p < 0.0001). CONCLUSION: The present findings suggest that almost 9 on 10 HSB subjects may receive a PIP including inappropriate prescriptions or absence of appropriate prescription. Bipolar disorder and/or major depression should be targeted in priority and treated with mood stabilizers and/or antidepressants in this population, while anxiolytics and hypnotics should be withdrawn as much as possible. Major depression should be particularly explored in subjects with comorbid antisocial personality disorder and substance use disorder. The psychiatric care has been associated with better appropriate psychotropic prescriptions and should be reinforced in this population.